CROI 2014: PrEP pilots to launch in resource-limited settings

BOSTON, MASS – Dr. Nelly Mugo from the Kenya Medical Research Institute in Nairobi was able to summarize the use of antiretroviral drugs to prevent HIV acquisition — pre-exposure prophylaxis, or PrEP — in resource limited settings quickly this week. That is because, after a series of clinical trials demonstrating the effectiveness of that prevention tool, by gay men, by injection drug users and by noninfected partners in sexual relationships with partners living with the virus, not much yet is going on in practice — no PrEP services in public health programs, no provider guidelines, no delivery models.

Mugo and colleagues are currently enrolling high risk HIV discordant couples in Nairobi in a pilot project. Ten pilots, including the one in Nairobi, are slated for sub-Saharan Africa as part of the Partners Demonstration Project. In addition to identifying priority populations to take part in the projects, questions that must be answered as the pilot is launched include how to assess HIV risk, and who is motivated to take PrEP.

Mugo argues that PrEP can be a bridge to antiretroviral therapy and viral suppression and the Kenya pilot aims to provide that bridge to the HIV-infected partner in the couples that enroll. So far, 620 couples are enrolled, with 95 percent of the HIV negative partners accepting PREP and 75 per cent of the HIV-infected partners willing to start antiretroviral therapy. Some of the concerns expressed by participants about PrEP included potential side effects, stigma and interaction with alcohol. Participants were not interested in getting PrEP and related services at HIV clinics.

Mugo compared some of the challenges and reluctance to implement PrEP with the introduction of oral contraceptives, when demand drove the public health guidance on oral contraceptives. Like the first oral contraceptives, the current PrEP formulations may not be perfect, but Mugo argued that perfection is not essential for PrEP to be a potent public health intervention. “Only 40 percent of Kenyan women receive family planning services, but it is still a major public health success.” according to Mugo. She called on prescribers to assist in facilitating rapid implementation of PREP as part of a comprehensive prevention package.

She also noted that the Kenyan parliament is considering legislation that would put it in the company of Uganda and Nigeria, further threatening the rights of lesbian, gay, bisexual and transgender people, and challenged health practitioners to make their voices heard: “Healthcare providers need to take a stand on access to healthcare services for all.”